Advances in immunosuppressive regimens have decreased the incidence of early graft rejection following lung transplantation. Despite the common use of antimetabolites, monoclonal antibodies, calcineurin inhibitors and IL-2 inhibitors in immunosuppressive protocols, high dose corticosteroids are also routinely administered. We hypothesize that reduction in corticosteroid administration will decrease opportunistic infection following lung transplantation.
Two groups of lung transplant recipients were compared in a retrospective review. Group 1 (n=26) received one gram of methylprednisolone prior to reperfusion of the transplant lung followed by three doses of 125 mg each over 24 hours. Group 2 (n=27) received only 500 mg of methylprednisolone prior to reperfusion. All patients underwent induction with daclizumab (1mg/kg) and were maintained with azathioprine (2mg/kg ), tacrolimus (0.04mg/kg, desired blood levels 10-20ng/ml), and prednisone (0.5 mg/kg/day, beginning POD 2) following transplantation. The two groups were compared with regard to patient survival, rejection episodes, and infectious complications at six months.
The two groups were comparable with regards to age, sex, transplant procedure, and cytomegalovirus (CMV) match. Episodes of rejection and patient survival were similar at six months post-transplant. Patients in Group 1 developed more opportunistic infections than patients in group 2 (50% vs 22% respectively, p = 0.06). No difference in the incidence of CMV infection was apparent, however patients in Group 1 developed more fungal and bacterial infections than patients in Group 2 (35% vs 7.4%, p = 0.03).
Reducing peri-operative steroid administration lowers infectious complications following lung transplantation. This benefit is realized without increasing the incidence of early rejection.
Opportunistic infectious complications following lung transplantation remain a major contributor for morbidity and mortality following lung transplantation. Manipulation of peri-operative steriod dosing appears to significantly affect opportunistic infections following lung transplantation and may contribute to reduction in morbidity associated with steriod usage.
S.H. Shah, None.